Module 3
Gastro-intestinal (including hepatobiliary)
1. Regarding the abdomen:
(a) By the fifth week of fetal life the gut tube within the peritoneal cavity is suspended by
the dorsal mesentery.
(b) The blind ending hind gut is closed by the cloacal membrane.
(c) The superior mesenteric artery supplies the gut from the inferior half of the duodenum
to the splenic flexure.
(d) The coeliac axis supplies the gut from the upper esophagus to the superior half of the
duodenum.
(e) The inferior mesenteric artery supplies the hind gut distal to the hepatic flexure up to
the anal canal.
2. In developmental anomalies of the gut:
(a) Failure of recanalization of the lumen of the midgut may result in atresia or stenosis of
the bowel.
(b) Meckel’s diverticulum represents the remains of the embryonic right umbilical vein.
(c) In an undescended caecum, neonatal intestinal obstruction is caused by Ladd’s band.
(d) Ischaemic changes to the bowel in the fetal umbilical hernia may result in atresia or
stenosis of the bowel.
(e) The embryonic vitello intestinal duct gives rise to the appendix
3. In the anterior abdomen:
(a) The superficial fascia has a superficial layer that is continuous with the superficial
perineal fascia.
(b) The paired rectus abdomini are separated by the linea alba.
(c) The rectus sheath is formed by the rectus muscles.
(d) The inguinal ligament is formed by the aponeurosis of the internal oblique muscle.
(e) The superior epigastric artery runs in the posterior rectus sheath.
4. Regarding the peritoneal ligaments:
(a) Between the two layers of the right coronary ligament is the bare area of the liver.
(b) The gastro-splenic ligament is a continuation of the lesser omentum from the stomach
to the spleen.
(c) The falciform ligament contains the ligamentum venosum in its free edge.
(d) The phrenicocolic ligament is continuous with the splenorenal ligament.
(e) The hepatoduodenal ligament transports the portal triad.
5. Regarding the oesophagus:
(a) The upper third is supplied by the inferior thyroid artery.
(b) The middle third is supplied by the branches of the aorta.
(c) The left gastric artery supplies the lower third.
(d) The lower third drains into the portal system.
(e) The upper oesophagus has lymphatic drainage to the mediastinal lymph nodes.
6. Regarding the duodenum:
(a) The second part is anterior to the hilum of the right kidney.
(b) The ampulla of Vater is in the posteromedial aspect of the second part.
(c) The fundus of the gall bladder lies anterior to the second part.
(d) The superior mesenteric vessels are posterior to the third part.
(e) The left psoas muscle is posterior to the terminal portion of the third part
7. Regarding the arteries of the upper abdomen:
(a) The cystic artery to the gall bladder usually arises from the right hepatic artery.
(b) The right gastric artery is a branch of the superior mesenteric artery.
(c) The gastroduodenal artery (GDA) arises usually from the right hepatic artery.
(d) The proximal GDA descends anterior to the first part of the duodenum.
(e) The GDA terminates into the right gastro-epiploic and anterior superior
pancreaticoduodenal arteries.
8. The superior mesenteric artery (SMA):
(a) arises from the anterior surface of the aorta at about the level of L1.
(b) gives rise to the dorsal pancreatic artery.
(c) gives rise to the middle colic artery inferior to the uncinate process.
(d) gives rise to the right colic artery in a third of individuals.
(e) gives rise to the inferior pancreatico-duodenal artery in the majority of cases.
9. Regarding the arteries of the lower abdomen:
(a) The inferior mesenteric artery arises from the anterior or left anterolateral aspect of the
aorta at the level of L1.
(b) The left colic artery anastomosis with the middle colic artery.
(c) The superior rectal artery is the terminal artery of the inferior mesenteric artery.
(d) The middle and inferior rectal arteries anastomose with the superior rectal artery.
(e) The marginal artery of Dwight runs close to the distal large bowel from which the vasa
recta arise.
10. The following are recognized anastomotic sites between portal and systemic
circulations:
(a) Azygos and left gastric veins.
(b) Superior rectal and middle rectal veins.
(c) Portal and hepatic veins.
(d) Ovarian and mesenteric veins.
(e) Left renal and splenic vein.
